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Introduction: Approximately 25%–43% of all vulvar carcinomas are associated with human papillomavirus (HPV). In many countries, vulvar carcinoma incidence rates are increasing, possibly due to greater HPV exposure. However, studies exploring changes in HPV prevalence and genotype distribution in vulvar carcinoma over time are scarce. Our aim was to evaluate time trends in HPV prevalence and genotype distribution in vulvar squamous cell carcinoma in an unselected, nationwide sample of Norwegian women. Further, we explored clinical and histopathological aspects in relation to HPV status and investigated whether HPV status was associated with survival. Material and methods: All vulvar squamous cell carcinoma cases from 1970–1975 and 2000–2005 were extracted from the Cancer Registry of Norway and corresponding tissue blocks were retrieved. After detailed histology review, HPV testing was conducted using real‐time TaqMan PCR. Overall survival rates were calculated using the Kaplan–Meier method. Multivariable Cox regression analysis was performed to estimate hazard ratios adjusted for age at diagnosis, stage and diagnostic period. Results: Histological review was performed on 352 vulvar squamous cell carcinoma cases. We were able to obtain valid HPV analysis results for 282 cases, Overall, 29.8% (95% CI 24.5%–35.5%) of cases were high‐risk HPV (hrHPV)‐positive. When comparing the two periods, we found that the percentage of hrHPV‐positive tumors increased significantly from 23% (95% CI 16.0%–31.4%) in 1970–1975 to 35.3% (95% CI 27.8%–43.3%) in 2000–2005 (P = 0.025). The predominant genotypes were HPV 16 (73%), HPV 33 (21%), and HPV 18 (6%), with similar distributions in both periods. In the more recent cohort, several additional genotypes were detected: HPV 6, 11, 39, 45, 52, 58 and 66 were found in smaller percentages, ranging from 1.8% to 3.6%. In univariate analysis, patients with HPV‐positive tumors showed improved overall survival compared with patients with HPV‐negative tumors (hazard ratio [HR] 0.65, 95% CI 0.48–0.86). Conclusions: The prevalence of HPV in vulvar squamous cell carcinomas in Norway was significantly higher in 2000–2005 than in 1970–1975. The three predominant genotypes were HPV 16, 33 and 18 in both time periods. However, several other HPV genotypes have emerged over the last decades. HPV‐positivity was associated with better overall survival. [ABSTRACT FROM AUTHOR]

Background: There is limited knowledge on the association between lifestyle behaviour in adolescence and musculoskeletal pain in young adulthood. This study aimed to investigate whether an accumulation of adverse lifestyle behaviours in adolescents with and without musculoskeletal pain at baseline, was associated with persistent musculoskeletal pain (pain duration ≥3 consecutive months the last year) 11 years later.Methods: Longitudinal data from the Trøndelag Health Study in Norway including 1824 adolescents (13-19 years old) was analysed. The outcome was persistent musculoskeletal pain (≥3 months). The number of adverse lifestyle behaviours (low physical activity level, sleep problems, insufficient fruit/vegetables consumption, smoking, frequent alcohol intoxication [drunkenness] and/or illicit drug use) were summed up to comprise an ordinal variable and analysed with 0 or 1 adverse behaviours as the reference. Multiple logistic regression analyses, stratified by individuals with and without baseline musculoskeletal pain, were conducted. The results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).Results: In adolescents with musculoskeletal pain at baseline, reporting ≥ four adverse lifestyle behaviours increased the odds of persistent musculoskeletal pain (OR 2.23, 95% CI 1.36, 3.66) 11 years later. Two and three adverse behaviours were not associated with future persistent musculoskeletal pain. In adolescents without musculoskeletal pain at baseline, an accumulation of adverse lifestyle behaviours was not associated with future persistent musculoskeletal pain.Conclusion: An accumulation of adverse lifestyle behaviours in adolescents with musculoskeletal pain at baseline was associated with persistent musculoskeletal pain 11 years later, but not in adolescents without musculoskeletal pain at baseline.Significance: An accumulation of four or more adverse lifestyle behaviours in adolescents with musculoskeletal pain was associated with persistent musculoskeletal pain in young adulthood. In future health care of adolescents with musculoskeletal pain, lifestyle behaviours should be assessed, with emphasis on accumulation of multiple adverse lifestyle behaviours. Focusing on an accumulation of multiple adverse lifestyle behaviours, rather than each individual behaviour, might provide a potential area for future research and interventions targeting musculoskeletal pain in youth. [ABSTRACT FROM AUTHOR]

Background: Pain is a serious problem for intensive care unit (ICU) patients, but we are lacking data on pain at the hospital ward after ICU discharge. Aims and Objectives: To describe pain intensity, ‐interference with function and ‐location in patients up to 1 year after ICU discharge. To identify demographic and clinical variables and their association with worst pain intensity and pain interference. Design: A longitudinal descriptive secondary analysis of a randomized controlled trial on nurse‐led follow‐up consultations on post‐traumatic stress and sense of coherence after ICU discharge. Methods: Pain intensity, ‐interference, and ‐location were measured using Brief Pain Inventory at the hospital ward and 3, 6, and 12 months after ICU discharge. For associations, data were analysed using multivariate linear mixed models for repeated measures. Results: Of 523 included patients, 68% reported worst pain intensity score above 0 (no pain) at the ward. Estimated means for worst pain intensity and –interference (from 0 to 10) after ICU discharge were 5.5 [CI 4.6‐6.5] and 4.5 [CI 3.7‐5.3], and decreased to 3.8 [CI 2.8‐4.8] (P ≤.001) and 2.9 [CI 2.1‐3.7] after 12 months (P ≤.001). Most common pain locations were abdomen (43%), lower lumbar back (28%), and shoulder/forearm (22%). At 12 months, post‐traumatic stress (PTS) symptoms ≥25 (scale 10‐70), female gender, shorter ICU stay, and more traumatic ICU memories were significantly associated with higher worst pain intensity. PTS symptoms ≥25, female gender, more traumatic ICU memories, younger age, and not having an internal medical diagnosis were significantly associated with higher pain interference. Conclusions: Early after ICU discharge pain was present in 68% of patients. Thereafter, pain intensity and ‐interference declined, but pain intensity was still at a moderate level at 12 months. Health professionals should be aware of patients' pain and identify potentially vulnerable patients. Implication for Practice: Longitudinal assessment of factors associated with pain early after ICU discharge and the following year is a first step that could improve follow‐up focus and contribute to reduced development of chronic pain. [ABSTRACT FROM AUTHOR]

Background: The "Large observational study to understand the global impact of severe acute respiratory failure" (LUNG SAFE) study described the worldwide epidemiology and management of patients with acute hypoxaemic respiratory failure (AHRF). Here, we present the Nordic subset of data from the LUNG SAFE cohort. Methods: We extracted LUNG SAFE data for adults fulfilling criteria for AHRF in intensive care units (ICU) in Denmark, Norway and Sweden, including demographics, co‐morbidities, clinical assessment and management characteristics, 90‐day survival and length‐of‐stay (LOS). We analysed ICU LOS with linear regression, and associations between risk factors and mortality were quantified using Cox regression. Results: We included 192 patients, with a median age of 64 years (IQR 55, 72), and a male‐to‐female ratio of 2:1. The majority had one or more co‐morbidities, and clinicians identified pneumonia as the primary cause of respiratory failure in 56% and acute respiratory distress syndrome (ARDS) in 21%. Median ICU LOS and duration of invasive mechanical ventilation (IMV) were 5 and 3 days. Tidal volumes (TV) were frequently larger than that supported by evidence and IMV allowing for spontaneous ventilation was common. Younger age, co‐morbidity, surgical admission and ARDS were associated with ICU LOS. Sixty‐one patients (32%) were dead at 90 days. Age and a non‐surgical cause of admission were associated with death. Conclusions: In this subset of LUNG SAFE, ARDS was often not recognised in patients with AHRF and management frequently deviated from evidence‐based practices. ICU LOS was generally short, and mortality was attributable to known risk factors. [ABSTRACT FROM AUTHOR]

Background: Moderate/severe pain after total knee arthroplasty (TKA) is a poor surgical outcome. Many studies have identified preoperative risk factors of pain after TKA, but studies of the joint contributions of co‐occurring symptoms are lacking. Methods: Patients undergoing primary TKA (n = 202) were enrolled in a longitudinal cohort study. Preoperatively, patients completed questionnaires measuring demographics and symptoms (pain, fatigue, sleep problems and depression). Pain was re‐assessed 12 months after TKA. Logistic regression analysis was used to compute the probabilities of moderate‐severe pain at 12 months based on preoperative symptom levels, and results were combined into a risk matrix. Results: More than one‐third (40%) of patients (n = 187) reported moderate‐severe pain after TKA. Among preoperative risk factors included in the logistic regression analyses were age, sex, pain, fatigue, sleep problems and depression. Adjusting for possible confounders, fatigue (p = 0.02) and pain (p = 0.01) were significant risk factors for moderate‐severe pain at 12‐months follow‐up and were retained in the final risk matrix. The co‐occurrence of high‐preoperative fatigue and pain scores resulted in 57% estimated probability of moderate‐severe pain at 12 months. Similarly, the co‐occurrence of low‐preoperative fatigue and pain scores resulted in 14% estimated probability of moderate‐severe pain 12 months after TKA. Conclusion: The combination of high fatigue and pain scores prior to surgery was a key risk factor for moderate‐severe pain 12 months after TKA. Mapping of these factors could be used preoperatively to identify patients who are at risk to experience a poor outcome of TKA. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the effects of two aerobic exercise programs of different intensities on energy expenditure.Methods: This was a single-center randomized controlled trial of patients with severe obesity allocated to a 24-week moderate-intensity continuous training (MICT) program or a combined MICT with high-intensity interval training (HIIT/MICT) program. The primary outcome was energy expenditure during exercise (EEDE). Secondary outcomes included resting metabolic rate, cardiorespiratory fitness, and body composition.Results: A total of 82 (56% females) patients were screened, and 71 (55% females) patients were allocated to HIIT/MICT (n = 37) or MICT (n = 34). Per-protocol analysis showed that EEDE increased by 10% (95% CI: 3%-17%) in the HIIT/MICT group (n = 16) and 7.5% (95% CI: 4%-10%) in the MICT group (n = 24), with no differences between groups. In the 8- to 16- week per-protocol analysis, the HIIT/MICT group had a significantly larger increase in EEDE compared with the MICT group. Resting metabolic rate remained unchanged in both groups. HIIT/MICT and MICT were associated with significant weight loss of 5 kg and 2 kg, respectively.Conclusions: Patients completing a 24-week combined HIIT/MICT program did not achieve a higher EEDE compared with those who completed a 24-week MICT program. The HIIT/MICT group experienced, on average, a 3-kg-larger weight loss than the MICT group. [ABSTRACT FROM AUTHOR]

Objectives: Cisplatin-related hearing loss (HL) is claimed to progress after treatment. This controlled longitudinal study with extended follow-up investigates HL in testicular cancer survivors (TCSs) after cisplatin-based chemotherapy (CBCT).Study Design: Controlled longitudinal study.Methods: Eighty-two TCSs treated with CBCT between 1980 and 1994 in Norway participated in two surveys (S1/S3), including pure-tone audiograms (0.125-8 kHz) and self-reported HL, 12 and 31 years after treatment, respectively. Hearing thresholds were age-adjusted based on age-matched hearing thresholds from the general population (controls). Hearing loss was defined as thresholds >20 dB at any frequency.Results: Between the two surveys, the prevalence of high-frequency HL (4, 6, and 8 kHz) increased from 73% to 94% but approached those of the aging general population after age adjustment. In TCSs aged >40 years at first survey, HL at the subsequent survey equaled that of controls. Self-reported HL increased from seven (9%) at S1 to 20 (26%) at S3. At S1, age-adjusted HL was identified in all (seven) TCSs reporting decreased hearing whereas at S3, hearing thresholds did not differ from controls in seven out of 20 patients reporting HL.Conclusion: CBCT-related ototoxicity causes high-frequency HL, but in contrast to reports from follow-up studies from the first post-treatment decade, no major progression was found beyond the first post-treatment decade for frequencies 0.125-8 kHz. Importantly, with extended follow-up, hearing thresholds of patients approach those of the general population, possibly due to a less-than-additive effect with age-related hearing loss (ARHL) in CBCT-treated patients. Age-and sex-matching is strongly advised in long-term follow-up of CBCT-related ototoxicity. Specificity for detecting ototoxicity with self-reported questionnaires decreases with extended follow-up.Level Of Evidence: 3 Laryngoscope, 130:E515-E523, 2020. [ABSTRACT FROM AUTHOR]

Aim: We aimed to compare modifiable cardiometabolic risk factors among treatment-seeking adolescents with obesity in Italy, Germany and Norway.Methods: This retrospective, registry-based, cross-sectional cohort study included 2,327 (59% girls) 12-18 year-old adolescents with obesity from three tertiary care outpatient clinics in Europe, between 1999 and 2015. The prevalence of cardiometabolic risk factors was compared between clinics, and multivariate logistic regression models including gender, age, waist circumference and body mass index were used to assess the associations between population and cardiometabolic risk.Results: In total, 1,396 adolescents (60% girls) from Italy, 654 (58% girls) from Germany and 277 (51% girls) from Norway were included. The mean ± SD age was 15.2 ± 1.6 years, body mass index 38.8 ± 6.5 kg/m2 and body mass index standard deviation score 3.21 ± 0.43. The prevalence of elevated nonhigh-density lipoprotein-cholesterol in Norway, Germany and Italy was 60%, 54% and 45%, while the prevalence of high systolic or diastolic blood pressure (≥130 or ≥85 mmHg) were 15%, 46% and 66%, respectively.Conclusion: Cardiometabolic risk factors among treatment-seeking adolescents with obesity from Italy, Germany and Norway differed across the populations in this study, which might imply that preventive clinical work should reflect such differences. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in potential long-term outcomes following intensive care, but few researchers have studied the prevalence of multiple symptoms or the association between pain and other symptoms. Aims: To investigate the prevalence of anxiety, depression, fatigue, sleep disturbance and post-traumatic stress symptoms (PTSS) among intensive care survivors 3 months and 1 year after being discharged from an intensive care unit (ICU) and to determine whether pain is associated with higher prevalence of these symptoms 3 months and 1 year after ICU stay. Study design: Exploratory, longitudinal cohort of intensive care survivors from two mixed ICUs in a tertiary referral hospital in Norway. Methods: Intensive care survivors completed surveys at 3 months (n=118) and 1 year (n=89) after ICU discharge. Clinical Trials: NCT02279212. Results: Prevalence rates of intensive care survivors' symptoms were pain 58 (49·2%), anxiety/depression 24/118 (20·8%), fatigue 18/118(15·3%), PTSS 15 (12·8%) and sleep disturbance 58/118 (49·2%) at 3 months after ICU discharge (n=118). Prevalence rates at 1 year (n=89) changed only slightly to pain 34 (38·2%), anxiety/depression 17 (20·0%), fatigue 12 (13·8%), PTSS 13 (15·1%) and sleep disturbance 40/89 (46·5%). Associations were strong between pain and presence of sleep disturbance, anxiety/depression, PTSS and fatigue. Conclusions: Intensive care survivors have multiple symptoms and the prevalence rates of these symptoms remained almost unchanged from 3 months to 1 year after ICU discharge. The presence of pain was associated with high odds for the presence of sleep disturbance, anxiety/depression, PTSS and fatigue, compared to a no-pain group. ICU survivors may benefit from targeted interventions designed to alleviate the symptom burden. Relevance to clinical practice: Knowledge about ICU survivor's prevalence and risk for having multiple symptoms may help health care professionals to give better care, if needed, to the ICU survivors. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Studies comparing adverse effects after different treatment methods are few and lack information on additional treatment and cancer relapse. Some US studies have provided population-based estimates on adverse effects, however, figures from Europe are most often based on mono-institutional experience or multicentre studies from high-volume university-affiliated hospitals with selected patient populations. Few studies have investigated the relationship between presence of urinary, bowel or sexual dysfunction and global quality of life ( QoL)., This population-based study investigated real-life practice with regard to prostate cancer in men who were potential candidates for curative treatment, based on high-quality national registry data. Treatment groups of recurrence-free men who completed their treatment or who received no cancer treatment were measured as to adverse effects, global QoL and the association between them. The study shows that each treatment method is associated with distinct patterns of urinary, bowel and sexual dysfunction and that irritative-obstructive urinary symptoms are associated with increased risk of low global QoL. This large survey also investigates the use of medication for erectile dysfunction and the relationship between such use and global QoL., Objectives To provide population-based estimates of typical adverse effects ( AEs), e.g. urinary, bowel and sexual dysfunction, in patients with non-metastatic recurrence-free prostate cancer ( PCa) by curative treatment method, including no treatment., To describe associations between typical AEs and global quality of life ( QoL) and to study patients' use of medication for erectile dysfunction ( EDmed) and the relationship between such use and global QoL., Patients and Methods In October 2006 a national population-based sample of PCa survivors diagnosed in 2004 was invited to a postal survey focusing on treatment-related AEs and global QoL, 12-32 months after treatment start. All had completed their initial treatment., In the present study, 771 compliers were categorized into four groups of localized or locally advanced PCa related to the treatment they completed: (i) no treatment; (ii) radical prostatectomy ( RP); (iii) radiotherapy ( RAD) without hormones; and (iv) RAD with hormone therapy of 3-24 months duration., Measurement of AEs was restricted to function, using selected items from the 50-item Expanded Prostate Cancer Index Composite and the Brief Sexual Function Inventory among others, whereas global QoL was measured with the 12-item short-form health survey., National prescription data enabled assessment of adjuvant hormone application and EDmed use., Results Men who had undergone RP reported more urinary incontinence (24%) than the other treatment groups, but had the lowest level of moderate/severe urinary irritative-obstructive symptoms. Men from the 'no treatment' group had the highest level of moderate/severe irritative-obstructive urinary symptoms. Men who had undergone RAD reported higher levels of irritative intestinal symptoms and faecal leakage compared with the RP group and the no treatment group., In all treatment groups, poor sexual drive and poor erectile function were common AEs, with men treated with RP reporting the highest prevalence of poor erectile function (89%)., Presence of irritative-obstructive urinary symptoms and poor sexual drive were independently associated with low global QoL in multivariate analyses., Fifty percent of the study group had used EDmed after treatment start, but only 47% of them were still using EDmed at the time of the survey. Use of EDmed was not significantly associated with global QoL., Conclusions PCa survivors after curative treatment, but also patients without any anticancer therapy, report high levels of urinary and sexual AEs., Irritative-obstructive urinary symptoms and poor sexual drive were significantly associated with low global QoL, whereas erectile function and use of EDmed were not. [ABSTRACT FROM AUTHOR]